Research of Insomnia Treatment with Intravenous Injections of Flunitrazepam in Clinical Practice

Abstract

Internal medicine cannot be used to treat insomnia for inpatients with dysphagia if tube administration is not possible. In such cases, injectable benzodiazepine with a high level of safety is often used in Japan. While a benzodiazepine antagonist is available, there is insufficient data on safe administration methods. Therefore, a survey was conducted to identify the usage status of intravenous injections of flunitrazepam, which is frequently used among injectable benzodiazepines. The survey covered all patients admitted to our hospital between April 1, 2017 and March 31, 2018 on whom intravenous injections of flunitrazepam were used, except for those whose SpO₂ was 95％ or less prior to the intravenous injections of flunitrazepam. For the subjected 45 patients, the median of the maximum daily dose for intravenous injections of flunitrazepam was 1 mg (0.3 - 2); the incidence of respiratory depression (SpO₂ was less than 90％) was 33.3％ (15 patients). Twenty-six patients (57.8％) were able to take a meal or use internal medicines with flunitrazepam. An abnormal value of aspartate aminotransferase (AST) was extracted as a factor independently affecting the incidence of respiratory depression (OR = 15.10, 95％CI: 1.610 - 142.0, P = 0.018). As a safe method of administration for intravenous injections of flunitrazepam, it is necessary to appropriately evaluate, before administration, whether or not internal medicine can be used, and if possible, to recommend internal medicine that can be adapted. When administering flunitrazepam by intravenous injection, pay particular attention to patients with an abnormal AST value and it is desirable to monitor their respiratory status during administration.